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Student Visa Credit Cards

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					OFFICE USE ONLY Client no.:                                        Date received:              /    /           Application no.:


                                                                                                                                     INZ 1012



                                                                           Student Visa/Permit
                                                                                    Application
                                                                                                    for a temporary stay in New Zealand


                                                 Use the guide to help you complete the application form
                                               Please read the Student Visa/Permit Guide (INZ 1013) before you complete this
                                               application form. The guide will help you decide which visa or permit you should apply
                                   for and contains helpful information about how to complete the application form. The guide
                                   also gives detailed information about the evidence and documents you need to send.
                                   When you have completed the form, please use the checklist at the end to make sure you
                                   have sent all the documents and information we need.
                                   We will process your application only when we receive all the information and documents we
                                   need. If you do not send all the required information, we will return your application.
                                   Your partner or other family members cannot apply on this application form. They must lodge
                                   separate applications for the type of visa or permit they need.
                             Immigration Advisers Licensing Act 2007
                             Under the Immigration Advisers Licensing Act 2007, anyone giving immigration advice will
  have to be licensed (unless they are exempt). From 4 May 2009, all immigration advisers working in New Zealand must
  be licensed. From 4 May 2010, all immigration advisers, whether working onshore or offshore, must be licensed. It is an
  offence to provide immigration advice without holding a licence from these dates. If your immigration adviser is not
  licensed when they should be, Immigration New Zealand will return your application.
  For more information and to view the Register of licensed advisers, go to the Immigration Advisers Authority website
  www.iaa.govt.nz, email info@iaa.govt.nz or write to them at PO Box 6222, Wellesley Street, Auckland 1141, New Zealand.
  When filling in this form, please print clearly in English using CAPITAL LETTERS.


 Section A        Personal details
All applicants must complete this section.
     For more information about the questions in this section see ‘Completing Section A: Personal details’ in
     the Student Visa/Permit Guide.

Attach one passport-size photograph of yourself here. The photograph must be less than
six months old. Write your full name on the back of the photograph.

A1 Name as shown in passport                                                                                                 4.5cm

     Family/last name


     Given/first name(s)                                                                                                             3.5cm




A2 Preferred title       Mr       Mrs      Ms       Miss      Dr      other (please specify)

A3 Other names you are known by or have ever been known by




       For further information on immigration
       visit www.immigration.govt.nz
   When filling in this form, please print clearly using CAPITAL LETTERS.




    A4 Your name in ethnic script

    A5 Gender            Male         Female             A6 Date of birth

    A7 Town/city of birth

          Country of birth

    A8 Passport number                                                                                            Expiry date
                                                                                                                   D   D   M   M   Y   Y   Y   Y




          Country

    A9 Country of citizenship

    A10 Other citizenships you hold

    A11 Partnership status                           Married/in civil union          Never married/never in civil union                            Partner
                                                     Separated                       Engaged                Widowed                                Divorced


     Section B         Contact details

   All applicants must complete this section.
          For more information on the questions in this section see ‘Completing Section B: Contact details’ in the Student Visa/Permit Guide.

    B1 Your residential address and telephone number in your home country

          Address



          Telephone (daytime)                                                      Telephone (evening)

          Fax                                                     Email

    B2 Your New Zealand residential address and telephone number (if you are already in New Zealand)

          Address



          Telephone (daytime)                                                      Telephone (evening)

          Fax                                                     Email

    B3 Name and address for communication about this application.

             Same as address at          B1   , or            Same as address at      B2   , or          Other.
          Family/last name                                                    Given/first name(s)



          Company name (if applicable) and address



          Telephone (daytime)                                                      Telephone (evening)

          Fax                                                     Email




2 – Student Visa/Permit Application
B4 Do you authorise the person stated at                    B3   to act on your behalf?                Yes          No

B5 Have you received immigration advice on this application?
        Yes Please make sure that your immigration adviser completes Section L: Immigration adviser’s details. Go to               B6

        No Go to     B7 .


B6 Immigration adviser reference code for online enquiries                                                           This is not the adviser’s licence number.

B7 Would you like us to email you instructions for registering to check online how your application is progressing?
        Yes        No

B8 Names and addresses of friends, relatives, or contacts you have in New Zealand (if applicable)
     Name                                                                                             Relationship



     Address

     Name                                                                                             Relationship



     Address

B9 List all periods of employment, including self-employment
      Date from    (DD/MM/YY)     Date to   (DD/MM/YY)           Name of employer                        Location              Type of work/occupation/job title
            /         /                /        /
            /         /                /        /
            /         /                /        /
            /         /                /        /
            /         /                /        /
            /         /                /        /



 Section C          Your health

All applicants must complete this section.
     For more information about the questions in this section, see ‘Completing Section C: Your health’ in the Student Visa/Permit Guide.

C1 Do you have pulmonary tuberculosis (TB)?                          Yes Provide details         No




C2 Do you have any medical condition that requires, or may require, one of the following during your stay in New Zealand?
   •	Renal	dialysis	      Yes      No
   •	Hospital	care	       Yes      No
   •	Residential	care	    Yes      No
     Residential care is long-term care provided in live-in facilities for the aged or for people with physical, sensory, intellectual, or psychiatric disabilities.

C3 If you have answered Yes to any of the questions in                        C2   , please provide details




C4 Are you pregnant?                 Yes        No



                                                                                                                                  Student Visa/Permit Application – 3
   When filling in this form, please print clearly using CAPITAL LETTERS.



   Medical certificates you must provide

    C5 Do you intend to study in New Zealand for less than six months? If you are in New Zealand, this includes time you
       have already spent here.     Yes. You do not need to provide a medical certificate. Go to C11 . No. Go to C6 .

    C6 Have you submitted a medical certificate with another Immigration New Zealand application?
             Yes. Provide details then go to   C7         No. Go to   C8 .

                                                                                                                                 D   D      M    M   Y    Y      Y   Y
             Type of application                                                                       Date of application

    C7 Was the medical certificate completed and dated by a Medical Practitioner within the last 24 months?
             Yes. You do not need to provide a further medical certificate now. We will tell you if we need any further
             information, such as tests, reports, or a new medical certificate . Go to C11 .
             No. Go to   C8 .


    C8 How long do you intend to stay in New Zealand? If you are in New Zealand, this includes time you have already spent here.
             More than six months but not more than 12 months. Go to                  C9 .

             More than 12 months. You must provide a Medical and Chest X-ray Certificate (NZIS 1007). Go to                              C11 .


    C9 See the list ‘Countries, areas, and territories with a low incidence of tuberculosis’ in ‘Completing Section C: Your
       health’ of the Student Visa/Permit Guide. Please tick one of the options below.
             I am from a place that is on the list. Go to          C10 .

             I am from a place that is not on the list. Write the name of the place below. You must provide a completed
             Temporary Entry X-Ray Certificate (NZIS 1096) with your application. Go to C11 .
             Name of country, area or territory

    C10 Please tick one of the options below.
             I have not spent three months or more in the past five years in a place that is not on the list. You do not have to
             provide a medical certificate at this stage. Go to C11 .
             I have spent three months or more in the past five years in a place that is not on the list. Provide details


             You must provide a completed Temporary Entry X-Ray Certificate (NZIS 1096) with your application. Go to                                     C11 .


    C11 Please tick one of the options below.
             I do not have to provide a medical certificate at this stage.
             I attach a Temporary Entry X-ray Certificate (NZIS 1096).
             I attach a Medical and Chest X-ray Certificate (NZIS 1007).
          Note that children under the age of 11 years and pregnant women are not required to have an X-ray, unless a special report is needed.


     Section D           Your character
   All applicants must complete this section. Note: if your application is declined for character reasons, Immigration
   New Zealand may place a notation in your passport indicating that you applied for a visa for New Zealand.

    D1 Have you been:
          •	convicted	                     Yes      No
          •	charged	                       Yes      No
          •	under	investigation	           Yes      No
          for any offence(s) against the law in any country?

    D2 Have you been:
       •	deported	                                  Yes       No
       •	excluded	(refused	entry)	                  Yes       No
       •	removed	                                   Yes       No
       from any country?



4 – Student Visa/Permit Application
     If you have answered Yes to any of the questions in                     D1   and     D2   , please provide details below.




Police certificates you must provide
D3 Do you intend to study in New Zealand for 24 months or longer? If you are in New Zealand, this includes time you
   have already spent here.
        Yes. Go to   D4 .

        No. You do not need to provide any police certificates at this stage. Go to Section E: Your visa or permit.

D4 Are you 17 years or over?
        Yes. Go to   D5 .

        No. You do not need to provide evidence about your character. Go to Section E: Your visa or permit.

D5 Have you sent a police certificate to Immigration New Zealand that was issued within the last six months?
        Yes. Provide details           No. Go to      D6 .

        Type of application                                                           Date of application D D                           M   M   Y   Y   Y   Y

        We will tell you if we need any further information about your character. Go to Section E: Your visa or permit.

D6 You must provide evidence about your character. Please tick to confirm what evidence you have provided.
        I have attached police certificates from my country or countries of citizenship, and
        I have attached police certificates from all countries I have lived in for five years or more since the age of 17.

D7 If you have not provided all of the police certificates required, please explain why.




 Section E        Your visa or permit
All applicants must complete this section.
     For more information about the questions in this section, see ‘Completing Section E: Your visa or permit’ in the Student Visa/Permit Guide.

E1   Please tick one of the boxes below to show the type of visa or permit you are applying for and provide the date
     of your arrival in New Zealand if applicable.
        Applying for a student visa

        Date you will enter New Zealand   D   D   M    M     Y   Y   Y   Y

        Applying for a student permit
        Applying for a limited purpose visa. List the reasons below.

        Date you will enter New Zealand on a limited purpose visa        D   D    M   M   Y    Y   Y   Y

        Applying for a further limited purpose permit. List the reasons below.
     If you are applying for a further limited purpose visa or permit, list the reasons.




E2 Are you applying for a variation of conditions, as part of your application for a student visa or permit?
        Yes       No




                                                                                                                            Student Visa/Permit Application – 5
   When filling in this form, please print clearly using CAPITAL LETTERS.



     Section F         Your course of study
   All applicants must complete this section, apart from:
   •	 dependent	children	with	domestic	student	status
   •		 partners	of	work	permit	holders.
          For more information about the questions in this section, see ‘Completing Section F: Your course of study’ in the Student Visa/Permit Guide.

     F1   When does your course start?                D   D   M   M   Y    Y   Y   Y


    F2 When does your course finish?                  D   D   M   M   Y    Y   Y   Y


    F3 Provide the date to which your course fees have been paid. If you have a scholarship, provide the date your

          scholarship ends      D     D   M   M   Y   Y   Y   Y


    F4 Details of the course or courses you have enrolled in
           Name of institution where you will be studying                 Qualification you will be studying       Location of the institution in
                                                                                                               New Zealand where you will be studying




   Your offer of a place and the fees you have paid
    F5       I have attached an offer of a place at a New Zealand education or training institute.

    F6 Please tick one of the options below
          I have attached evidence that I have paid the course fees.
          I have attached evidence that I am exempt from paying the course fees. (If you have been accepted on an
          approved student exchange scheme, attach evidence from the scheme organiser that you have been accepted.)
     F7   If you already hold a student permit and you are applying for a further student permit, you must provide additional
          evidence. Please send photocopies, not original documents.
              I have attached evidence of my previous student performance.
              I have attached evidence of satisfactory attendance and progress (primary and secondary students only).
              Not applicable.

     Section G         Financial support while you are in New Zealand
   All applicants must complete this section, apart from:
   •	 dependent	children	with	domestic	student	status
   •		 people	applying	for	a	student	visa	or	permit	on	the	basis	of	their	partner’s	immigration	status	(this	includes	
       partners	of	New	Zealand	citizens	and	residents,	and	partners	of	some	work	permit	holders).
          For more information about the questions in this section, see ‘Completing Section G: Financial support while you are in New Zealand’ in
          the Student Visa/Permit Guide.

    G1 Please tick the box or boxes that apply to you.
          I have attached a completed Financial Undertaking for a Student (INZ 1014).
          I have attached copies (not originals) of evidence that I have sufficient funds.
          I have attached copies (not originals) of evidence that my accommodation and living costs are already paid.
          I have attached a Sponsorship Form for Visiting New Zealand (INZ 1025) or a written guarantee of maintenance,
          accommodation, and repatriation from a relative in New Zealand who is either a New Zealand citizen or resident.
          Note that this option is for students from Tonga or Samoa only.
    G2 What arrangements have you made for outward travel from New Zealand?




6 – Student Visa/Permit Application
 Section H       Your parent or legal guardian
See	‘Completing	Section	H:	Your	parent	or	legal	guardian’	in	the	Student Visa/Permit Guide to find out if you have to
complete this section and for more information about the questions. If you do not have to complete this section, go to
Section J: Additional details.

H1 Name of legal guardian as shown in their passport

      Family/last name

      Given/first name(s)

H2 Other names your legal guardian is known by

H3 Gender                 Male     Female                    H4 Date of birth   D   D   M   M   Y    Y   Y   Y


H5 Place of birth

      Country of birth

H6 Passport details

      Number

      Country                                                                                       Expiry date       D   D   M   M     Y   Y   Y    Y


H7 Country of citizenship

H8 Other citizenships your parent or legal guardian holds

H9 Relationship to you:          Mother   Father   Legal guardian


Documents you must provide about your parent or legal guardian

H10 Have you attached evidence that your legal guardian usually cares for you in your home country?
        Yes     No

H11 Please tick one of the following:
        I am to be treated as a domestic student because of my parent or legal guardian’s immigration status,
        and I have included evidence about my legal guardian
        I must be accompanied by a legal guardian and I have included evidence about my legal guardian
        Not applicable.

 Section I       Partnership-based applications
Complete	this	section	if	you	are	applying	for	a	student	visa	or	permit	on	the	basis	of	your	partner’s	immigration	status.
See	‘Completing	Section	I:	Partnership-based	applications’	in	the	Student Visa/Permit Guide to find out if you have to
complete this section and for more information about the questions.

 I1   Does your partner support your application?               Yes    No

 I2   Are you and your partner living in a genuine and stable partnership?                  Yes          No
      If you have answered No, please explain why.




 I3   Do you and your partner meet the minimum requirements for the recognition of a partnership?                                 Yes           No




                                                                                                                 Student Visa/Permit Application – 7
   When filling in this form, please print clearly using CAPITAL LETTERS.



   Partnership evidence you must provide
     I4   Please tick the box to confirm that you have attached the evidence we require.
             I have attached a completed Form for partners supporting partnership-based temporary entry applications (INZ 1146).
             I have attached copies (not originals) of evidence that I am living with my partner in a genuine and stable partnership.

     Section J          Additional details
   Complete this section if you are 17 years or over. If you are under 17 years of age, go to Section K: Declaration by applicant.
     J1   Do you have a national identity number, or other unique identifier that was issued to you by any government?

             Yes. National identity number/unique identifier
             No

    J2    Have you completed military service in any country?
             No
             Yes. Please provide information about your military service including the dates of your military service, your position and rank, the unit or units
             that you served in, and your role within each unit.

           Date from   (DD/MM/YY)     Date to   (DD/MM/YY)                  Rank                  Unit name or number                     Role
                  /      /               /          /
                  /      /               /          /
                  /      /               /          /
                  /      /               /          /
                  /      /               /          /
                  /      /               /          /

          Please list any military identity numbers you were given.

    J3 Are you presently subject to military service obligations in any country?                             Yes       No
          If you have answered No, and you are a citizen of a country in which compulsory military service exists, please give details.




    J4 Have you been associated with any intelligence agency or group, or law enforcement agency?                                        Yes       No
          If you have answered Yes, please describe how you were involved




    J5 Have you been associated with any group or organisation that has used or promoted violence to further their aims?
             Yes       No
          If you have answered Yes, please describe how you were involved




    J6 Have you ever committed or been involved in war crimes, crimes against humanity, and/or human rights abuses?
             Yes       No
          If you have answered Yes, please describe how you were involved




8 – Student Visa/Permit Application
 Section K          Declaration by applicant
All applicants must complete this section.
I have provided true and correct answers to the questions in this form.
I agree to tell Immigration New Zealand about any changes to my circumstances that occur after making this application.
I agree to leave New Zealand before my permit expires. If I remain in New Zealand after my permit has expired, I may be
removed by Immigration New Zealand.
I agree that if I am not entitled to free health care in New Zealand, I will pay for any health care or medical assistance
I may require in New Zealand.
I understand that if I have received immigration advice from an immigration adviser and if that immigration adviser
is not licensed under the Immigration Advisers Licensing Act 2007 when they should be, Immigration New Zealand will
return my application.
I authorise Immigration New Zealand to provide information about my health and my immigration status to any health
service agency. I authorise any health service agency to provide information about my health to Immigration New Zealand.
I authorise Immigration New Zealand to make any necessary enquiries about information on this form so that they can:
•	make	a	decision	on	this	application
•	answer	enquiries	about	my	immigration	status	once	my	application	has	been	decided.
I authorise any agency that holds information (including personal information) related to those matters to disclose that
information to Immigration New Zealand.
If I am granted a student permit with the condition that I am accompanied by a legal guardian, I agree to live with my legal
guardian. I understand that my permit and the permit of my legal guardian may be withdrawn if I do not meet this condition.
If I am granted a limited purpose permit, I agree that I will leave New Zealand on or before the expiry date of that permit.
If I do not leave New Zealand, I may be immediately removed from New Zealand without the right of appeal.

Signature of applicant

                                                                                                                    Date     D   D   M    M   Y   Y        Y   Y

Note that a parent or guardian may sign on behalf of a child under 17 years.


 Section L          Immigration adviser’s details
This	section	must		be	completed	by	the	applicant’s	immigration	adviser.	If	the	applicant	does	not	have	an	immigration	
adviser, this section does not have to be completed.

 L1   Have you been lawfully present in New Zealand for more than 183 days in the last 12 months?                                    Yes          No

L2    Tick the one option that applies to you.

          I am a licensed immigration adviser under the New Zealand Immigration Advisers Licensing Act 2007. Go to                                    L3

          I am exempt from licensing under the New Zealand Immigration Advisers Licensing Act 2007. Go to                                L4

          I am an unlicensed immigration adviser. Go to Section M: Declaration by person assisting the applicant.
      If you are unlicensed when you should be licensed under the Immigration Advisers Licensing Act 2007, Immigration New Zealand will return your
      client’s application. It is an offence to provide immigration advice without holding a licence, unless you are exempt.


L3    Licensed advisers. Please provide your licence details.
      Licence type
         full                provisional                      limited. List conditions specified in the Register.




      Licence number 2 0                                   Go to Section M: Declaration by person assisting the applicant.




                                                                                                                        Student Visa/Permit Application – 9
   When filling in this form, please print clearly using CAPITAL LETTERS.




    L4    Exempt from licensing. Tick one box below to show why you are exempt from licensing.
            I provided immigration advice in an informal or family context only, and I did not provide the advice systematically
            or for a fee.
            I am a New Zealand member of Parliament or member of their staff and I provided immigration advice as part of
            my employment agreement.
            I am a foreign diplomat or consular staff.
            I am an employee of the New Zealand public service and I provided immigration advice within the scope of my
            employment agreement.
            I am a lawyer and I hold a current practising certificate as a barrister or as a barrister and solicitor of the High
            Court of New Zealand.
            I am employed by, or I am working as a volunteer for, a New Zealand community law centre where at least one lawyer
            is on the employing body of the community law centre or is employed by or working as a volunteer for the community
            law centre in a supervisory capacity.
            I am employed by, or I am working as a volunteer for, a New Zealand citizens advice bureau.
            I provided immigration advice offshore in relation to applications or potential applications for student visas or
            student permits only.
           Go to Section M: Declaration by person assisting the applicant.

     Section M         Declaration by person assisting the applicant

   This	section	must	be	completed	and	signed	by	the	applicant’s	immigration	adviser,	or	by	any	person	who	has	assisted	
   the applicant by providing immigration advice, explaining, translating, or filling in the form for the applicant. If the
   applicant does not have an immigration adviser, and no one helped the applicant to fill in this form, this section does
   not have to be completed.
   If you are unlicensed when you should be licensed under the Immigration Advisers Licensing Act 2007, Immigration New Zealand return your client’s
   application. It is an offence to provide immigration advice without holding a licence.
   For more information, go to the Immigration Advisers Authority website www.iaa.govt.nz, or email info@iaa.govt.nz or write to them at PO Box 6222,
   Wellesley Street, Auckland 1141, New Zealand.

   Name and address of person assisting applicant.                    Same as address given at                   B3 , or           as below.
   Family/last name                                                         Given/first name(s)


   Company name (if applicable) and address




   Telephone (daytime)                                                                Telephone (evening)

   Fax                                                            Email

   I understand that after the applicant has signed this form it is an offence to change or add further information, change
   any documents attached to the form, or attach any further documents to the form.
   I note that the maximum penalty for this offence is a fine of up to NZ$100,000 and/or a term of imprisonment of up to
   seven years. However, if changes are needed, the person making the changes must state on the form what information
   or documents have been changed and give reasons for the changes.
   I certify that the applicant asked me to help them complete this form and any additional forms. I certify that the applicant
   agreed that the information provided was correct before signing the declaration.
         I have assisted the applicant as an interpreter/translator
         I have assisted the applicant with filling in the form
         I have assisted the applicant in another way. Please specify
      I have provided immigration advice (as defined in the Immigration Advisers Licensing Act 2007) and my
      details in Section L: Immigration adviser’s details are correct.
   Signature of person assisting

                                                                                                                             Date      D   D    M     M   Y   Y   Y   Y




10 – Student Visa/Permit Application                                   This form has been approved under section 132(1) of the Immigration Act 1987
        About the information
        you provide
Deciding whether you are eligible for a visa or permit
Immigration New Zealand collects the information about
you on this form to decide whether you are eligible for a
student visa or permit or a limited purpose visa or permit.
We may also use the information to contact you for research
purposes or to advise you on immigration matters.
The address of Immigration New Zealand is PO Box 3705,
Wellington, New Zealand. This is not where your application
should be sent.
Collecting the information is authorised by the Immigration
Act 1987 and the Immigration Regulations made under that
Act. You do not have to provide the information, but if you do
not we are likely to decline your application.

Deciding whether you are eligible to board a flight
to New Zealand
The information we collect may also be used to determine
whether you are allowed to board a flight to New Zealand.
We will not share your personal information with airline
check-in agents; however, we will send a boarding message
to the airline check-in agent based on the information you
have provided in this form.
Immigration New Zealand may also share the information
you have provided with other government agencies that
are entitled to it by law, or with other agencies (as you have
agreed in the declaration).
If you come to New Zealand, you will be able to ask to see
the information we hold about you and have any of it
corrected if you think it is necessary.

Other documents we may need
Sometimes we may ask for additional documents or
information so that we can consider it with this application.

Other documents you may wish to send
You may wish to send other documents or information
so that we can consider it with this application. Please
send photocopies only (not original documents), as these
documents will not be returned to you. If we need to see an
original document, you will be asked to produce it later.

For more information
If you have questions about completing the form:
•	see	our	website	www.immigration.govt.nz
•	telephone	our	call	centre	on	0508	558	855	(within New Zealand)
•	contact	one	of	Immigration	New	Zealand’s	offices.
Immigration New Zealand has offices in Apia, Bangkok, Beijing,
Hong Kong, Jakarta, London, Moscow, New Delhi, Nuku’alofa,
Shanghai, Singapore, Suva, Sydney, and Taipei, You can also
contact New Zealand diplomatic and consular offices.
In New Zealand offices are located in Auckland, Henderson,
Manukau, Hamilton, Palmerston North, Wellington,
Christchurch, and Dunedin.




                                                                   Student Visa/Permit Application – 11
   When filling in this form, please print clearly using CAPITAL LETTERS.



     Section N             Paying your application fee                                Application checklist
   Please see Immigration New Zealand’s Fees Guide (INZ 1028).
                                                                                      OFFICE
                                                                                       USE     Information and documents you must supply             CHECK
                                                                                                                                                      LISt
                                                                                       ONLY

   See our website www.immigration.govt.nz/fees for                                       I have completed and signed the
   more information about:                                                                application form.
   •	current	fees                                                                         I have provided my application fee.
   •	payment	methods.                                                                     I have attached my passport or travel
                                                                                          document (the original document).
   Your application fee                                                                   I have attached a recent passport-size
   Amount you are paying:                                                                 photograph.
                                                                                      Additional information and documents you may
   Currency                                                                           need to supply
                                                                                      Health
   Application number                                                                          I have provided evidence about my health.
   (office use only)
                                                                                               I do not have to provide this evidence.
   Preferred methods of payment                                                       Character
                                                                                               I have provided evidence about my character.
   We recommend that you use one of the following
                                                                                               I do not have to provide this evidence.
   methods of payment for better security and
                                                                                      Course of study
   faster processing:
                                                                                               I have provided evidence of my enrolment.
      Bank cheque/bank draft
                                                                                               I have provided evidence of my enrolment
   Credit card* (choose one)                                                                   and evidence of my previous student
          Mastercard                               Visa                                        performance (applicants for further
                                                                                               student visa or permit only).
       SWITCH card (UK only)
                                               SWITCH card issue number                        I do not have to provide this evidence.
   Name of cardholder                                                                 Financial support
                                                                                               I have provided evidence of how I will support
                                                                                               myself financially while I am in New Zealand.
   Card number                                                                                 I do not have to provide this evidence.
                                                                                      Parent or legal guardian
                                                                                               I have provided evidence about my parent
                                                                                               or legal guardian.
   Expiry date     D   D   M   M   Y   Y   Y   Y
                                                                                               I do not have to provide this evidence.
   Signature of cardholder                                                            Exchange scheme students only
                                                                                               I attach evidence from the scheme
                                                                                               organiser that I have been accepted on to
                                                                                               an approved student exchange scheme.
   Date    D   D   M   M   Y   Y   Y   Y                                              Partnership-based applications only
                                                                                               I have attached a completed Form for
   Other methods of payment                                                                    partners supporting partnership-based
                                                                                               temporary entry applications (INZ 1146).
       Personal cheque. Note that we will hold your application for
                                                                                               I have attached copies (not originals) of
       10 working days to allow the cheque to be cleared.
                                                                                               evidence that I am living with my partner in
       Cash. Cash should not be sent through the mail for security reasons.                    a genuine and stable partnership.

   We do not accept money orders.                                                     Returning your documents
   To be removed and securely destroyed after credit card                             Please tick one of the following options
   transaction is processed
                                                                                      I wish to collect my documents when ready.
                                                                                      (This option is not available to applicants in New Zealand.)
   *Your CVC/CVV number is required if you are paying
   by electronic credit card and your application is being                            Please return all documents to me by secure
   lodged at Immigration New Zealand’s Bangkok branch or                              post at the address given at B3 .
   London branch, or the MFAT post in The Hague.
   If your application will be lodged in one of these three
   branches, please provide your CVC/CVV number here.
              Note: your CVC/CVV number is the three-digit number
   found on the signature strip on the back of your credit card.



12 – Student Visa/Permit Application                                      MAY 2009   MAY 2009

				
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